Circadian rhythm biomarker from wearable device data is related to concurrent antidepressant treatment response

Major depressive disorder (MDD) is associated with circadian rhythm disruption. Yet, no circadian rhythm biomarkers have been clinically validated for assessing antidepressant response. In this study, 40 participants with MDD provided actigraphy data using wearable devices for one week after initiating antidepressant treatment in a randomized, double-blind, placebo-controlled trial. Their depression severity was calculated pretreatment, after one week and eight weeks of treatment. This study assesses the relationship between parametric and nonparametric measures of circadian rhythm and change in depression. Results show significant association between a lower circadian quotient (reflecting less robust rhythmicity) and improvement in depression from baseline following first week of treatment (estimate = 0.11, F = 7.01, P = 0.01). There is insufficient evidence of an association between circadian rhythm measures acquired during the first week of treatment and outcomes after eight weeks of treatment. Despite this lack of association with future treatment outcome, this scalable, cost-effective biomarker may be useful for timely mental health care through remote monitoring of real-time changes in current depression.


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2 nature portfolio | reporting summary

March 2021
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The findings apply to both sexes. Sex was considered in study design with oversampling of females who are more likely to experience depression. The sex variable was used as a fixed effect and covariate in statistical analyses. The summary tables include the number of females in non-remitters vs. remitters groups.

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The study mostly included university age population with an average of 31 years.

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The participants were recruited as an optional add-on from a randomized clinical trial for imaging.

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Clinical trial registration Advancing Personalized Antidepressant Treatment Using PET/MRI, ClinicalTrials.gov: NCT02623205. This actigraphy study was an optional add-on to this clinical trial.

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This actigraphy study was an optional add-on to this clinical trial. The Study Protocol can be accessed at: https://clinicaltrials.gov/ ProvidedDocs/05/NCT02623205/Prot_SAP_000.pdf

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The motor activity data was acquired as an optional component of a randomized, placebo-controlled, double-blind, single-site trial of the SSRI escitalopram with brain imaging. Briefly, 77 participants completed the trial after 8 discontinued, 57 of whom opted for actigraphy. The clinical and demographic variables were measured at Stony Brook University and the Actigraphy data was collected at the participants' living environment between 7/5/2017 and 03/13/2020.

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Depression severity was quantified by trained raters using the 17-item Hamilton Depression Rating Scale (HDRS) before initiating treatment, and at the end of the first and eighth week of treatment.
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